{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:12:28Z","timestamp":1790115148402,"version":"4.0.1"},"reference-count":23,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2003,5,1]],"date-time":"2003-05-01T00:00:00Z","timestamp":1051747200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2003,5]]},"abstract":"<jats:p>Objective: To describe a case of fatal mouthwash ingestion and review possible sources of toxicity. Design: Case report. Setting: Veterans Administration Medical Center. Patient: Single patient with massive mouthwash ingestion. Main results: This patient was a 45-year-old man who developed cardiovascular collapse and multiorgan system failure following a massive ingestion of mouthwash (almost 3 liters). His presentation was remarkable for a profound anion-gap metabolic acidosis and a significant osmolar gap. No other co-ingestants were identified, and he expired despite full supportive care including dialysis and mechanical ventilation. An autopsy failed to identify any other cause of death. Nonalcoholic ingredients of this mouthwash are phenolic compounds (eucalyptol, menthol, and thymol), and large-volume mouthwash ingestion will produce exposure in the reported toxic range of these ingredients. Conclusions: When ingested in large quantities, the phenolic compounds in mouthwash may contribute to a severe anion-gap metabolic acidosis and osmolar gap, multiorgan system failure, and death. These compounds, in addition to alcohol, may account for the adverse effects associated with massive mouthwash ingestion.<\/jats:p>","DOI":"10.1177\/0885066602250783","type":"journal-article","created":{"date-parts":[[2003,8,8]],"date-time":"2003-08-08T23:46:59Z","timestamp":1060386419000},"page":"150-155","source":"Crossref","is-referenced-by-count":19,"title":["Fatal Large-Volume Mouthwash Ingestion in an Adult: A Review and the Possible Role of Phenolic Compound Toxicity"],"prefix":"10.1177","volume":"18","author":[{"given":"Guy W. Soo","family":"Hoo","sequence":"first","affiliation":[{"name":"Pulmonary and Critical Care Section, VA Greater Los Angeles Healthcare System, UCLA School of Medicine."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Hinds","sequence":"additional","affiliation":[{"name":"Pulmonary and Critical Care Section, VA Greater Los Angeles Healthcare System, UCLA School of Medicine."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"Dinovo","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Service, West Los Angeles Healthcare Center, VA Greater Los Angeles Healthcare System, UCLA School of Medicine."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W.","family":"Renner","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Service, West Los Angeles Healthcare Center, VA Greater Los Angeles Healthcare System, UCLA School of Medicine."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2003,5,1]]},"reference":[{"key":"atypb1","doi-asserted-by":"crossref","unstructured":"1. Weller-Fahy ER, Berger LR, Troutman WG. Mouthwash: a source of acute ethanol intoxication . Pediatrics. 1980;66: 302-304 .","DOI":"10.1542\/peds.66.2.302"},{"key":"atypb2","unstructured":"2. Shulman JD, Wells, LM. Acute ethanol toxicity from ingesting mouthwash in children younger than 6 years of age . Pediatr Dent. 1997;19: 404-408 ."},{"key":"atypb3","doi-asserted-by":"publisher","DOI":"10.1177\/000992288502400312"},{"key":"atypb4","doi-asserted-by":"crossref","unstructured":"4. Sperry K, Pfalzgraf B. Fatal ethanol intoxication from household products not intended for ingestion . J Forens Sci. 1990;35: 1138-1142 .","DOI":"10.1520\/JFS12936J"},{"key":"atypb5","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-6757(99)90254-1"},{"key":"atypb6","doi-asserted-by":"publisher","DOI":"10.1053\/ajem.2000.9261"},{"key":"atypb7","doi-asserted-by":"publisher","DOI":"10.1053\/ajem.2001.25272"},{"key":"atypb8","doi-asserted-by":"publisher","DOI":"10.15288\/jsa.1985.46.473"},{"key":"atypb9","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-4679(99)00134-1"},{"key":"atypb10","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/166.9.833"},{"key":"atypb11","unstructured":"11. Harvey SC. Phenols, cresols and resorcinols. In: Gilman AG, Goodman LS, Gilman A, eds. The Pharmacologic Basis of Therapeutics. 6th ed. New York: MacMillan ; 1981:967-970."},{"key":"atypb12","unstructured":"12. Stajduhar-Caric Z. Acute phenol poisoning: singular findings in a lethal case . J Forens Med. 1968;15: 41-42 ."},{"key":"atypb13","doi-asserted-by":"publisher","DOI":"10.1016\/S0361-1124(79)80222-1"},{"key":"atypb14","doi-asserted-by":"crossref","unstructured":"14. Soares ER, Tift JP. Phenol poisoning: three fatal cases . J Forens Med. 1982;27: 729-731 .","DOI":"10.1520\/JFS12184J"},{"key":"atypb15","unstructured":"15. Agency for Toxic Substances and Disease Registry. Toxicologic Profile for Phenol. Atlanta, Ga: U.S. Public Health Services, U.S. Department of Health and Human Services ; 1998."},{"key":"atypb16","unstructured":"16. WHO working group. TA: Environmental Health Criteria. PG:151 p YR:1994 IP VI:161. Geneva, Switzerland: World Health Organization ."},{"key":"atypb17","unstructured":"17. Woo OF. Phenol and related compounds. In: Olsen KR, ed. Poisoning and Drug Overdose. 2nd ed. Norwalk, Conn: Appleton & Lange ; 1994:249-251."},{"key":"atypb18","doi-asserted-by":"crossref","unstructured":"18. Blake KD. Dangers of common cold treatments in children . Lancet. 1993;341: 640 .","DOI":"10.1016\/0140-6736(93)90410-I"},{"key":"atypb19","doi-asserted-by":"crossref","unstructured":"19. I'Mullane NM, Joyce P, Kamath SV, Tham MK, Knass D. Adverse CNS effects of menthol-containing olbas oil . Lancet. 1982;1: 1121 .","DOI":"10.1016\/S0140-6736(82)92297-8"},{"key":"atypb20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197505222922109"},{"key":"atypb21","unstructured":"21. Gosselin RE, Hodge HC, Smith RP, Gleason MN. Clinical Toxicology of Commercial Products. 4th ed. Baltimore: Williams and Wilkins ; 1976."},{"key":"atypb22","unstructured":"22. Gosselin RE, Smith RP, Hodge HC. Clinical Toxicology of Commercial Products. 5th ed. Baltimore: Williams and Wilkins ; 1984."},{"key":"atypb23","unstructured":"23. Gossel TA, Bricker JD. Principles of Clinical Toxicology. 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